Billing ID & Service 
Location

Billing Full Name
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 

Paid (Warrant) 
Amount
$2,061,904.30
$2,428,834.07
$3,107,633.42
$3,388,739.39
$3,713,299.25

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC RTC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC RTC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC RTC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC RTC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC RTC 

$6,672,495.73
$6,064,167.37
$5,769,113.12
$5,653,740.47
$5,205,732.37

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 

$1,054,810.38
$1,070,532.31
$1,134,324.79
$1,113,282.61
$1,017,063.06

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM‐SPECIALTY
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM‐SPECIALTY
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM‐SPECIALTY
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM‐SPECIALTY
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM‐SPECIALTY

$6,712,937.46
$6,938,425.86
$7,046,953.30
$6,674,142.49
$6,070,868.46

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM 

$2,066,203.23
$1,780,114.27
$1,740,686.83
$1,893,267.04
$1,391,040.31

SHADOW MOUNTAIN HOPE 
SHADOW MOUNTAIN HOPE 
SHADOW MOUNTAIN HOPE 
SHADOW MOUNTAIN HOPE 
SHADOW MOUNTAIN HOPE 

$1,365,713.96
$1,397,617.96
$1,327,469.90
$1,294,085.80
$1,243,046.87

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC 

$3,578,655.91
$3,550,736.91
$3,277,397.13
$3,396,327.87
$2,874,817.72
Inpatient Total:

Total Reimbursement 
Amount
$2,061,904.30
$2,428,834.07
$3,107,633.42
$3,388,739.39
$3,713,299.25
$14,700,410.43
$6,672,495.73
$6,064,167.37
$5,769,113.12
$5,653,740.47
$5,205,732.37
$29,365,249.06
$1,054,810.38
$1,070,532.31
$1,134,324.79
$1,113,282.61
$1,017,063.06
$5,390,013.15
$6,712,937.46
$6,938,425.86
$7,046,953.30
$6,674,142.49
$6,070,868.46
$33,443,327.57
$2,066,203.23
$1,780,114.27
$1,740,686.83
$1,893,267.04
$1,391,040.31
$8,871,311.68
$1,365,713.96
$1,397,617.96
$1,327,469.90
$1,294,085.80
$1,243,046.87
$6,627,934.49
$3,578,655.91
$3,550,736.91
$3,277,397.13
$3,396,327.87
$2,874,817.72
$16,677,935.54
$115,076,181.92

Final Issue Dte ‐ 
State Fiscal Yr
2012
2013
2014
2015
2016

Claim 
Type
I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

2012
2013
2014
2015
2016

I
I
I
I
I

 Billing ID & Service 
Location

Billing Full Name
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, INC 

Paid (Warrant) 
Amount
$8,118,818.00
$8,637,034.13
$9,683,604.52
$9,928,767.35
$9,489,983.74
Shopp Total:
Grand Total:

Total Reimbursement 
Amount
$8,118,818.00
$8,637,034.13
$9,683,604.52
$9,928,767.35
$9,489,983.74
$45,858,207.74
$160,934,389.66

Final Issue Dte ‐ 
State Fiscal Yr
2012
2013
2014
2015
2016

Claim 
Type
3
3
3
3
3

MAR State COS Sub Code 
Desc
004065 ‐ HSP ‐ SHOPP                              
004065 ‐ HSP ‐ SHOPP                              
004065 ‐ HSP ‐ SHOPP                              
004065 ‐ HSP ‐ SHOPP                              
004065 ‐ HSP ‐ SHOPP